ROAD specialties not as appealing anymore?

[oncology2020]

Ever feel like ROAD specialities have now become over-rated?

R = Radiology = need to do 1-2 fellowships in addition to the 5 year-residency before getting a job, treated like a sweat-shop worker with reading film after film after film, decreasing reimbursements after public and media scrutiny on their high salaries, no longer competitive as it once was
O = Ophthalmology = not a life-style specialty during residency, decreasing reimbursements
A = Anesthesiology = mid-levelers taking over, decreasing reimbursements, no longer competitive as it once was
D = Dermatology = decreasing reimbursements, increasing public and media scrutiny on their salaries (see radiology and NY Times articles once every year)

we entered medicine at the worst possible time

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[1badmamajama]

Well, I'm glad there are more than these 4 specialties in medicine.

 

[Arkangeloid]

Everybody still wants to do Derm I think.

 

[Kahreek]

I thought the O was for ortho.

 

[tco]

Crap? They're overrated now?! Can I change my residency choice still? :'(

Sent from my SCH-I535 using Tapatalk

 

[TheWeeIceMan]

Oceans rise. Cities fall. Derm survives.

 

[tco]

Oceans rise. Cities fall. Derm survives.

I'm glad some people love it, because you literally could not pay me enough...

Sent from my SCH-I535 using Tapatalk

 

[SouthSideSteve]

O = Ophthalmology = not a life-style specialty during residency, decreasing reimbursements

lol what? I cant imagine Optho residents having it that bad. Also only an idiot judges a lifestyle speciality based on residency.


The answer to your question is no. Even if you want to act like rads is horrible, rad onc and interventional are still good subspecialities. Anesthesia is still a good lifestyle with good pay. Derm isnt going anywhere, as others have said.

 

[SurgeDO]

Oceans rise. Cities fall. Derm survives.

really curious as to why midlevels have not started taking over derm yet.

 

[SouthSideSteve]

really curious as to why midlevels have not started taking over derm yet.

There are plenty of midlevels in Derm.

PAs don't want to 'take over' any field. CRNAs are a unique circumstance and the AANA has only made it worse.

 

[username456789]

really curious as to why midlevels have not started taking over derm yet.

Hate to beat a dead horse or sound like I'm demonizing midlevels, but this reminded me of another great story.

75 year old male who has been treated for 18 months(!) for simultaneous onset of "hand/foot eczema" and "diffuse drug hypersensitivity" (Lotrel, apparently) by a local derm PA who works under a derm physician (who, for his sake, I am going to assume has never laid eyes on or discussed the patient before). Multiple modalities of treatment including topical steroids, months of narrow-band UVB, and more topical steroids and emollients failed to improve this coincidental combination of conditions.

He's referred to our clinic. I walk in to greet him and the man is a page ripped right out of a derm textbook (Bolognia or Andrews, take your pick). My medical student with me (who is going into anesthesiology and has little interest in derm) exclaims excitedly "wow this guy looks just like that picture I saw of pityriasis rubra pilaris! neat!"

I mean this guy is literally PRP personified. Oh are those waxy keratotic plaques on your palms and soles? Those are rather handsome confluent salmon colored patches and plaques with islands of sparing you've got there. And how about those nutmeg grater follicular papules.

The poor guy even brought pictures from a year prior, and he looked exactly the same. So it's not like this was occult PRP masquerading as something else. There literally is no differential when a guy this classic walks in your door. It's PRP. He'd been jerked around by a PA for over a year.

There's a happy ending though: I started the guy on acitretin and he's not red anymore.

 

[DrBowtie]

Rads is still appealing....you still don't have to deal with patients.

 

[Dral]

Another thread that will likely turn into butt-hurts trashing Derm.

Anyway, I think the decreasing reimbursements are across the board. Path is getting hit really hard for instance.

I think chiro actually got a good boost.

 

[@JackShephard]

Hate to beat a dead horse or sound like I'm demonizing midlevels, but this reminded me of another great story.

75 year old male who has been treated for 18 months(!) for simultaneous onset of "hand/foot eczema" and "diffuse drug hypersensitivity" (Lotrel, apparently) by a local derm PA who works under a derm physician (who, for his sake, I am going to assume has never laid eyes on or discussed the patient before). Multiple modalities of treatment including topical steroids, months of narrow-band UVB, and more topical steroids and emollients failed to improve this coincidental combination of conditions.

He's referred to our clinic. I walk in to greet him and the man is a page ripped right out of a derm textbook (Bolognia or Andrews, take your pick). My medical student with me (who is going into anesthesiology and has little interest in derm) exclaims excitedly "wow this guy looks just like that picture I saw of pityriasis rubra pilaris! neat!"

I mean this guy is literally PRP personified. Oh are those waxy keratotic plaques on your palms and soles? Those are rather handsome confluent salmon colored patches and plaques with islands of sparing you've got there. And how about those nutmeg grater follicular papules.

The poor guy even brought pictures from a year prior, and he looked exactly the same. So it's not like this was occult PRP masquerading as something else. There literally is no differential when a guy this classic walks in your door. It's PRP. He'd been jerked around by a PA for over a year.

There's a happy ending though: I started the guy on acitretin and he's not red anymore.

I agree that derm is harder than the average med student thinks.

 

[GangaMaster]

 

[solitarius]

we entered medicine at the worst possible time

Are you surprised? Writing has been on the wall for awhile now.

 

[atomi]

ROAD is a a 1980s anachronism.

Since people love acronyms, the new ROAD (to happiness) for the 2010s is:

PROP (up your life?)

PM&R: On of the easiest easiest residencies. I know guys that finish by 2PM and spend the afternoon running 10 miles most days. High quality of life with normal work hours out of residency as well. I've never heard anyone say they regret it.
Rad-onc: Formerly the last resort specialty for foreign grads, now super competitive and one of the best lifestyle/reimbursement specialty. There is very little negative to say about this field except perhaps a few saturated markets in certain areas of the country. No threat of losing ground to other specialties (unless med onc invents a magic bullet), fantastic reimbursements, high quality of life in residency (little call, scheduled clinic days, weekends free), highly collegial environment. You're curing cancer with state of the art technology that actually works. What's not to love?
Optho: Don't know about that comment about lifestyle during residency being bad. It's still one of the best in terms of hours worked. Plus its one of the few surgical sub-specialties where you can do an easy TY instead of a killer surgery prelim. Opthos still sit atop the reimbursement charts and also enjoy work where they immediately help people. They have little call and relatively few emergencies.
Psych: One of the few fields left where you can hang a shingle, exercise your business acumen, and get paid in cash. Being able to set your own schedule and work for yourself with <2 staff members is a rarity these days. Quality of life in residency is great, and best of all it's not competitive for US grads.

What do these all have in common? Reasonable work hours, reasonable residency quality of life, high/stable reimbursements, good public opinion, tangible/meaingful results of work with patients, little to no call or emergencies, collegial work environment, no major midlevel threats or turf encroachments, not dependent on a single procedure (coughGIcough), no internet forums full of doom-and-gloom or regrets.

Honorable mentions:
Derm: There's no denying they have the greatest lifestyle of them all, but the specialty has become notoriously competitive and is suffering a pretty bad public relations crisis. Too many "interesting" personalities.
Allergy: Great quality of life but requires IM residency and work for the most part can be pretty boring and low-impact.

Basically, the glory days of rads and gas are long gone. Still good fields, but not what they used to be. I also love how people commonly try to add EM to this list. LOL. No. What kind of screwed up world do we live in where people consider shift work a "good" lifestyle?

 

[dyspareunia]

Basically, the glory days of rads and gas are long gone. Still good fields, but not what they used to be. I also love how people commonly try to add EM to this list. LOL. No. What kind of screwed up world do we live in where people consider shift work a "good" lifestyle?

+10000

Urology anyone?

Pros:
High pay
Good hours
Good mix of procedures to clinic
No threat of losing ground to NPs, PAs, or anyone else
And the best part. PEENZ FOR DAYS

 

[Dral]

I thought I remembered seeing that the Ophtho job market was pretty bad now. Could have just been doom and gloom.

 

[TheWeeIceMan]

Yeah, I think PM&R is a bit underrated, and like Psych, it isn't that competitive. It doesnt' have the pay of the others, but the lifestyle seems great. Reminds me of one of PandaBearMD's blog posts about hell freezing over when the PM&R resident was in the hospital after 5 pm.

 

[JoshSt]

+10000

Urology anyone?

Pros:
High pay
Good hours
Good mix of procedures to clinic
No threat of losing ground to NPs, PAs, or anyone else
And the best part. PEENZ FOR DAYS

I agree with urology being one of the ideal lifestyle fields, if you can stand the last point, lol.

I think Anesthesiology is still a great lifestyle field, despite the rise of the CRNA's. In our job market, anesthesiologists are very well compensated (often better than general surgeons). Also, I think one's perception of the field depends on their exposure - at our institution residents/attendings get off at 2-3 P. However, I've talked with plenty of attendings in non-surgically related fields who say that it's a field with horrible hours. Depends on your location/situation, I guess.

Agree with the PROP's being great lifestyle fields too. Considered all of them but was bored in my rotations/shadowing experiences.

Radiology may not be the lifestyle field it once was but still by far the coolest ;-)

 

[@JackShephard]

ROAD is a a 1980s anachronism.

Since people love acronyms, the new ROAD (to happiness) for the 2010s is:

PROP (up your life?)

PM&R: On of the easiest easiest residencies. I know guys that finish by 2PM and spend the afternoon running 10 miles most days. High quality of life with normal work hours out of residency as well. I've never heard anyone say they regret it.
Rad-onc: Formerly the last resort specialty for foreign grads, now super competitive and one of the best lifestyle/reimbursement specialty. There is very little negative to say about this field except perhaps a few saturated markets in certain areas of the country. No threat of losing ground to other specialties (unless med onc invents a magic bullet), fantastic reimbursements, high quality of life in residency (little call, scheduled clinic days, weekends free), highly collegial environment. You're curing cancer with state of the art technology that actually works. What's not to love?
Optho: Don't know about that comment about lifestyle during residency being bad. It's still one of the best in terms of hours worked. Plus its one of the few surgical sub-specialties where you can do an easy TY instead of a killer surgery prelim. Opthos still sit atop the reimbursement charts and also enjoy work where they immediately help people. They have little call and relatively few emergencies.
Psych: One of the few fields left where you can hang a shingle, exercise your business acumen, and get paid in cash. Being able to set your own schedule and work for yourself with <2 staff members is a rarity these days. Quality of life in residency is great, and best of all it's not competitive for US grads.

What do these all have in common? Reasonable work hours, reasonable residency quality of life, high/stable reimbursements, good public opinion, tangible/meaingful results of work with patients, little to no call or emergencies, collegial work environment, no major midlevel threats or turf encroachments, not dependent on a single procedure (coughGIcough), no internet forums full of doom-and-gloom or regrets.

Honorable mentions:
Derm: There's no denying they have the greatest lifestyle of them all, but the specialty has become notoriously competitive and is suffering a pretty bad public relations crisis. Too many "interesting" personalities.
Allergy: Great quality of life but requires IM residency and work for the most part can be pretty boring and low-impact.

Basically, the glory days of rads and gas are long gone. Still good fields, but not what they used to be. I also love how people commonly try to add EM to this list. LOL. No. What kind of screwed up world do we live in where people consider shift work a "good" lifestyle?

Only problem is that legislation can change a lot of these fields. For example, I've read that some psych NPs are getting paid 150k and because of the same factors you mentioned, it's desirable for them.

The issue is, most of us are concerned with what will be happening 5-10 years from now and no one can predict this. 15 years ago Radiology was probably higher than derm and ortho.

I think Anesthesiology is still a great lifestyle field, despite the rise of the CRNA's. In our job market, anesthesiologists are very well compensated (often better than general surgeons).

Again the issue is, what is anesthesia going to do 10 years from now? Projecting from the last 5 years it may not be so hot.

 

[JoshSt]

Again the issue is, what is anesthesia going to do 10 years from now? Projecting from the last 5 years it may not be so hot.

Good point, I hope they do the right things to protect their field from mid-levels. I hope all of medicine fights the rise of mid-levels.

 

[SurgeDO]

i think general surgery is always underrated.

-tons of variety
-good money
-decent lifestyle*
-good mix of laproscopy/robotics and open procedures
-specialty has been around for a long time without being touched by mid levels.
-you are at the forefront of saving patients' lives...if you're into that kinda thing.


*i have experienced general surgeons who take on 80-100 hour work weeks as well as general surgeons who take 3 days of clinic, 2 days of OR (home by 5), and off on the weekends. lots of variability with how you run your practice.

 

[DermViser]

Ever feel like ROAD specialities have now become over-rated?

R = Radiology = need to do 1-2 fellowships in addition to the 5 year-residency before getting a job, treated like a sweat-shop worker with reading film after film after film, decreasing reimbursements after public and media scrutiny on their high salaries, no longer competitive as it once was
O = Ophthalmology = not a life-style specialty during residency, decreasing reimbursements
A = Anesthesiology = mid-levelers taking over, decreasing reimbursements, no longer competitive as it once was
D = Dermatology = decreasing reimbursements, increasing public and media scrutiny on their salaries (see radiology and NY Times articles once every year)

we entered medicine at the worst possible time

Yeah, you get a 2 out of 10 for that effort, gunner. If you're trying to convince people to not go for controllable lifestyle specialties, you're going to have to try harder than that.

 

[DermViser]

really curious as to why midlevels have not started taking over derm yet.

Bc so far Dermatology has not been stupid enough to act like Anesthesiology with CRNAs.

 

[DermViser]

Hate to beat a dead horse or sound like I'm demonizing midlevels, but this reminded me of another great story.

75 year old male who has been treated for 18 months(!) for simultaneous onset of "hand/foot eczema" and "diffuse drug hypersensitivity" (Lotrel, apparently) by a local derm PA who works under a derm physician (who, for his sake, I am going to assume has never laid eyes on or discussed the patient before). Multiple modalities of treatment including topical steroids, months of narrow-band UVB, and more topical steroids and emollients failed to improve this coincidental combination of conditions.

He's referred to our clinic. I walk in to greet him and the man is a page ripped right out of a derm textbook (Bolognia or Andrews, take your pick). My medical student with me (who is going into anesthesiology and has little interest in derm) exclaims excitedly "wow this guy looks just like that picture I saw of pityriasis rubra pilaris! neat!"

I mean this guy is literally PRP personified. Oh are those waxy keratotic plaques on your palms and soles? Those are rather handsome confluent salmon colored patches and plaques with islands of sparing you've got there. And how about those nutmeg grater follicular papules.

The poor guy even brought pictures from a year prior, and he looked exactly the same. So it's not like this was occult PRP masquerading as something else. There literally is no differential when a guy this classic walks in your door. It's PRP. He'd been jerked around by a PA for over a year.

There's a happy ending though: I started the guy on acitretin and he's not red anymore.

+1 for the patient case with the descriptive morphology
+1 for the patient getting better after your treatment
+2 for the non-derm aspiring/non-gunner rotator appreciating how awesome derm can be

 

[DermViser]

i think general surgery is always underrated.

-tons of variety
-good money
-decent lifestyle*
-good mix of laproscopy/robotics and open procedures
-specialty has been around for a long time without being touched by mid levels.
-you are at the forefront of saving patients' lives...if you're into that kinda thing.

*i have experienced general surgeons who take on 80-100 hour work weeks as well as general surgeons who take 3 days of clinic, 2 days of OR (home by 5), and off on the weekends. lots of variability with how you run your practice.

Yeah, except 5 years of general surgery is pure hell from a lifestyle standpoint. Midlevels haven't touched the specialty, bc they DON'T WANT IT - that's why they're going after fields that have good lifestyles, as most NPs are women ---> Derm, GI, etc.
Also, with swallowing up and consolidation of private practices by hospitals due to ever increasing govt. regulation, I wouldn't do general surgery with the intention of doing private practice, as you're not assured getting your weekends off.

 

[DermViser]

There are plenty of midlevels in Derm.

PAs don't want to 'take over' any field. CRNAs are a unique circumstance and the AANA has only made it worse.

CRNAs also aren't PAs (so they're not under the Board of Medicine), but are nurses (who fall under the Board of Nursing).

 

[DermViser]

Are you surprised? Writing has been on the wall for awhile now.

It's just too bad those in the SDN premed forum refuse to read/believe it. The first goal of Obamacare is to get "everyone" insured, the next goal after that will be to rachet down reimbursements immensely. That's why plans on the Obamacare exchanges have such narrow networks.

Dr. Ezekiel Emmanuel, Obamacare architect, ideologue, friend of Barack Obama
http://www.newrepublic.com/article/...l-book-excerpt-end-health-insurance-companies

"Americans hate health insurance companies. They are easy targets for everyone to beat up on. When premiums go up, we blame insurance companies; we do not blame the underlying hospitals or physicians who charge high prices that drive up insurance costs."

This coming from a liberal idealogue who works for the liberal think tank Centers of American Progress, who doesn't see patients by the way.

After this, lifestyle will definitely be more of an issue for medical students, more than ever.

 

[solitarius]

After this, lifestyle will definitely be more of an issue for medical students, than ever.

Trust me, I know. Lifestyle is THE #1 factor for me, with career longevity being a close second.

Surgery is just not worth it in this harsh environment. I also want to give PROPS to Atomi's PROP post, minus psychiatry. It's hard enough in this world dealing with the BS from sane people.

 

[cbrons]

Hate to beat a dead horse or sound like I'm demonizing midlevels, but this reminded me of another great story.

75 year old male who has been treated for 18 months(!) for simultaneous onset of "hand/foot eczema" and "diffuse drug hypersensitivity" (Lotrel, apparently) by a local derm PA who works under a derm physician (who, for his sake, I am going to assume has never laid eyes on or discussed the patient before). Multiple modalities of treatment including topical steroids, months of narrow-band UVB, and more topical steroids and emollients failed to improve this coincidental combination of conditions.

He's referred to our clinic. I walk in to greet him and the man is a page ripped right out of a derm textbook (Bolognia or Andrews, take your pick). My medical student with me (who is going into anesthesiology and has little interest in derm) exclaims excitedly "wow this guy looks just like that picture I saw of pityriasis rubra pilaris! neat!"

I mean this guy is literally PRP personified. Oh are those waxy keratotic plaques on your palms and soles? Those are rather handsome confluent salmon colored patches and plaques with islands of sparing you've got there. And how about those nutmeg grater follicular papules.

The poor guy even brought pictures from a year prior, and he looked exactly the same. So it's not like this was occult PRP masquerading as something else. There literally is no differential when a guy this classic walks in your door. It's PRP. He'd been jerked around by a PA for over a year.

There's a happy ending though: I started the guy on acitretin and he's not red anymore.

Lol was this the same person you talked about from the other thread?

 

[cbrons]

It's just too bad those in the SDN premed forum refuse to read/believe it. The first goal of Obamacare is to get "everyone" insured, the next goal after that will be to rachet down reimbursements immensely. That's why plans on the Obamacare exchanges have such narrow networks.

Dr. Ezekiel Emmanuel, Obamacare architect, ideologue, friend of Barack Obama
http://www.newrepublic.com/article/...l-book-excerpt-end-health-insurance-companies

"Americans hate health insurance companies. They are easy targets for everyone to beat up on. When premiums go up, we blame insurance companies; we do not blame the underlying hospitals or physicians who charge high prices that drive up insurance costs."

This coming from a liberal idealogue who works for the liberal think tank Centers of American Progress, who doesn't see patients by the way.

After this, lifestyle will definitely be more of an issue for medical students, more than ever.

The Emmanuels are certifiably evil scumbags.

The high prices are charged to 3rd party payers because

a.) people receiving the services do not bear the cost of said service directly. In other words, they charge it because they can get away with it.
b.) they need remuneration from someone for the large percentage of people who overuse the expensive parts of the system (I.e. the ER) at absolutely no cost.

 

[DermViser]

ROAD is a a 1980s anachronism.

Since people love acronyms, the new ROAD (to happiness) for the 2010s is:

PROP (up your life?)

PM&R: On of the easiest easiest residencies. I know guys that finish by 2PM and spend the afternoon running 10 miles most days. High quality of life with normal work hours out of residency as well. I've never heard anyone say they regret it.
Rad-onc: Formerly the last resort specialty for foreign grads, now super competitive and one of the best lifestyle/reimbursement specialty. There is very little negative to say about this field except perhaps a few saturated markets in certain areas of the country. No threat of losing ground to other specialties (unless med onc invents a magic bullet), fantastic reimbursements, high quality of life in residency (little call, scheduled clinic days, weekends free), highly collegial environment. You're curing cancer with state of the art technology that actually works. What's not to love?
Optho: Don't know about that comment about lifestyle during residency being bad. It's still one of the best in terms of hours worked. Plus its one of the few surgical sub-specialties where you can do an easy TY instead of a killer surgery prelim. Opthos still sit atop the reimbursement charts and also enjoy work where they immediately help people. They have little call and relatively few emergencies.
Psych: One of the few fields left where you can hang a shingle, exercise your business acumen, and get paid in cash. Being able to set your own schedule and work for yourself with <2 staff members is a rarity these days. Quality of life in residency is great, and best of all it's not competitive for US grads.

What do these all have in common? Reasonable work hours, reasonable residency quality of life, high/stable reimbursements, good public opinion, tangible/meaingful results of work with patients, little to no call or emergencies, collegial work environment, no major midlevel threats or turf encroachments, not dependent on a single procedure (coughGIcough), no internet forums full of doom-and-gloom or regrets.

Honorable mentions:
Derm: There's no denying they have the greatest lifestyle of them all, but the specialty has become notoriously competitive and is suffering a pretty bad public relations crisis. Too many "interesting" personalities.
Allergy: Great quality of life but requires IM residency and work for the most part can be pretty boring and low-impact.

Basically, the glory days of rads and gas are long gone. Still good fields, but not what they used to be. I also love how people commonly try to add EM to this list. LOL. No. What kind of screwed up world do we live in where people consider shift work a "good" lifestyle?

Several points:
- Ophtho is not a surgical subspecialty, in the traditional sense. You can even do a prelim Internal Medicine year before and still do Ophtho.

-Psych is reimbursed relatively low by insurance companies in general, as mental health services are not adequately covered, and the market for cash-only Psych probably works only in certain zip codes, i.e. Upper East Side Manhattan. Not every Psychiatrist can be the typical couch in a private practice specialty. They also have competition from mental health midlevels and Psychologists.

-The New York Times has hit several specialties: Derm, GI, Rads, EM, etc. which they deem making too much as part of their series of "Why are costs so high". They also have other articles that hit doctors IN GENERAL. Once specialty salaries start going down, they'll start going after all doctors salaries in general.

-If you add up the number of hours worked per week in EM, it's a damn good deal. That's why it's a lifestyle specialty. When you're done with your shift, you're done, no pager afterwards.

 

[DermViser]

The Emmanuels are certifiably evil scumbags.

The high prices are charged to 3rd party payers because

a.) people receiving the services do not bear the cost of said service directly. In other words, they charge it because they can get away with it.
b.) they need remuneration from someone for the large percentage of people who overuse the expensive parts of the system (I.e. the ER) at absolutely no cost.

He's the typical ivory tower academic - proclaiming on Mount Olympus on how medicine should be run, meanwhile, not being in the trenches with the rest of clinicians seeing patients.

 

[rads214]

Rads is still a lifestyle specialty (relatively speaking) in my opinion. As someone else mentioned, you don't have to see patients.

 

[username456789]

Lol was this the same person you talked about from the other thread?

Nope, different PA/different practice. This one at least works under a licensed Dermatologist (which almost makes this story worse). The previous one I mentioned is a PA who works under a licensed OB/Gyn and practices """Dermatology""" (multiple quotes necessary).

 

[SouthSideSteve]

Nope, different PA/different practice. The previous one I mentioned is a PA who works under a licensed OB/Gyn and practices """Dermatology""" (multiple quotes necessary).

In the other post you said it was a NP. So which is it? An OB/GYN PA wouldn't be doing derm on the side.

Earlier this week I had a patient referred to me from a "Dermatology NP" (she's an NP who works under an OB/Gyn MD, and they market themselves as "_____ Dermatology" . . . I won't even get started on that ridiculousness) for a photosensitive rash of a few months' duration (was worse in the summer, got a little bit better over the ensuing months). She showed up to my clinic with some lab results in hand that the NP had ordered:

CBC, CMP, ESR, CRP, Lipid panel, ANA, RF, TSH, B12/Folate, Vit D, Mg/Phos, TIBC, ferritin, HIV, Hep B/Hep C (various such studies), RPR, Lyme titer, morning cortisol, amylase/lipase, PTH.

For fuck's sake.

The only lab abnormality in that whole shitstorm was (yup, you guessed it) a low Vitamin D. That's it.

The diagnosis was slam dunk PMLE. Literally no testing is required to make that diagnosis. I shudder to think how much those tests cost (and how much blood the woman lost at the hands of the NP).

 

[username456789]

In the other post you said it was a NP. So which is it? An OB/GYN PA wouldn't be doing derm on the side.

Oops, definitely a PA for both.

Trust me, i agree that she SHOULDN'T be doing Derm, but that is what she does. Not "on the side" either. It's a complete farce.

 

[evilbooyaa]

All the ROAD specialties are still good lifestyle as an attending.

I thought ROAD historically meant specialties that paid very well along with lifestyle. In that case, R can now stand for either Radiology (continued downward pressure/attending job hunt issues/fellowship basically required may take it completely off the list) or Rad Onc.

O - Still Ophtho if you want lifestyle, Ortho if you want more cash.

A - Anesthesia is getting downward salary pressure, but I imagine there aren't a lot (if any) of MDAs making < 250k/year. Current attendings are kind of just accustomed to 500k/year or whatever (similar with Rads).

D - Derm is getting pay cuts but is still good life style and I believe every attending is still above 200k/year? If not 250k? All the derm residents (seriously, like 3-5 of you) can confirm/deny this.

If you're looking at lifestyle alone, go ahead and add PM&R/Psychiatry.

I think Urology should get a serious look as an addition as attending lifestyle can be pretty nice and the salaries are top notch.

How about URORAD

Urology
RadOnc
Ophtho/Ortho
Radiology
Anesthesia
Derm

 

[Psai]

Several points:
- Ophtho is not a surgical subspecialty, in the traditional sense. You can even do a prelim Internal Medicine year before and still do Ophtho.

-Psych is reimbursed relatively low by insurance companies in general, as mental health services are not adequately covered, and the market for cash-only Psych probably works only in certain zip codes, i.e. Upper East Side Manhattan. Not every Psychiatrist can be the typical couch in a private practice specialty. They also have competition from mental health midlevels and Psychologists.

-The New York Times has hit several specialties: Derm, GI, Rads, EM, etc. which they deem making too much as part of their series of "Why are costs so high". They also have other articles that hit doctors IN GENERAL. Once specialty salaries start going down, they'll start going after all doctors salaries in general.

-If you add up the number of hours worked per week in EM, it's a damn good deal. That's why it's a lifestyle specialty. When you're done with your shift, you're done, no pager afterwards.

Yeah, it's adding insult to injury because most of the articles bashing doctors are written by someone who actually trained here, Elisabeth Rosenthal. But she apparently lives in China so I don't know her deal. I guess she gets paid a lot to write doctor bashing articles. Just look at how Dr. Oz sold out and promotes garbage pseudoscience because that's what pays. They don't talk about the bs that doctors have to deal with and just harp on about how doctors are so greedy and get paid too much.

Also, I don't think that anesthesiologists allowed CRNAs because they're stupid, but because they were greedy. Now it's coming to bite future anesthesiologists in the ass with crap autonomy and no control while the people that sold out the profession get golden handshakes by selling their practices to AMCs in the twilight of their careers.

 

[DermViser]

Yeah, it's adding insult to injury because most of the articles bashing doctors are written by someone who actually trained here, Elisabeth Rosenthal. But she apparently lives in China so I don't know her deal. I guess she gets paid a lot to write doctor bashing articles. Just look at how Dr. Oz sold out and promotes garbage pseudoscience because that's what pays. They don't talk about the bs that doctors have to deal with and just harp on about how doctors are so greedy and get paid too much.

Also, I don't think that anesthesiologists allowed CRNAs because they're stupid, but because they were greedy. Now it's coming to bite future anesthesiologists in the ass with crap autonomy and no control while the people that sold out the profession get golden handshakes by selling their practices to AMCs in the twilight of their careers.

That's bc she doesn't practice clinical medicine either. She was an EM physician who apparently got "frustrated" with the system. She moved to China (of all places) and bc she liked writing, she took to that, and was asked by the NY Times, to write a column on the high costs of healthcare.

Yes, but if Anesthesiologists had hired PAs who by definition have to work under a physician as they are regulated by the Board of Medicine (or now the new AAs - anesthesiology assistants) they wouldn't have found the mess that they are in now.

 

[DermViser]

..

 

[DermViser]

Another thread that will likely turn into butt-hurts trashing Derm.

Anyway, I think the decreasing reimbursements are across the board. Path is getting hit really hard for instance.

I think chiro actually got a good boost.

Figures the govt would pay more for cracking backs rather than that fixing them (Ortho).

 

[moisne]

I agree with urology being one of the ideal lifestyle fields, if you can stand the last point, lol.

I think Anesthesiology is still a great lifestyle field, despite the rise of the CRNA's. In our job market, anesthesiologists are very well compensated (often better than general surgeons). Also, I think one's perception of the field depends on their exposure - at our institution residents/attendings get off at 2-3 P. However, I've talked with plenty of attendings in non-surgically related fields who say that it's a field with horrible hours. Depends on your location/situation, I guess.

Agree with the PROP's being great lifestyle fields too. Considered all of them but was bored in my rotations/shadowing experiences.

Radiology may not be the lifestyle field it once was but still by far the coolest ;-)

I wasn't sure what CRNA was - looked it up - they get paid more than primary care docs...

 

[Psai]

I wasn't sure what CRNA was - looked it up - they get paid more than primary care docs...

Yeah but that looks like a bubble ready to burst too. Starting salaries are already down from what I heard and they're making the same mistake as pharmacy (opening up a ton of schools and pumping out grads without any regard for the job market). Still, they're doing well for themselves with the 40 hour weeks and the whole physician taking responsibility for their mistakes thing anyway.

 

[Str8Baller]

Why isn't plastic surgery mentioned in these threads? Given how competitive it is I would assume that it would also meet the requirements for lifestyle and pay.

 

[yappy]

Why doesn't neurosurgery get a mention? SRS. That field is pretty interesting and has a lot to offer in terms of professional satisfaction. I"ve heard the pay is decent too.

 

[VisionaryTics]

Why isn't plastic surgery mentioned in these threads? Given how competitive it is I would assume that it would also meet the requirements for lifestyle and pay.

Why doesn't neurosurgery get a mention? SRS. That field is pretty interesting and has a lot to offer in terms of professional satisfaction. I"ve heard the pay is decent too.

Both of these fields have awful lifestyles. Neurosurgery speaks for itself, and most plastic surgeons aren't Beverley Hills 9-to-5ers. And those that are, how do you think they got there?

 

[Frazier]

As mentioned above, PRS isn't known for a fab lifestyle.

The true PRS residency is competitive largely because there are only ~80 spots available.

Hell, cut psychiatry residency spots down to 80 and the Step 1 average would most likely be well over 240 with pubs on the CV (given the old 2011 charting outcomes data). Boom...competitive.